Provider Demographics
NPI:1336905835
Name:WILLIAMS, KAMILLE (RBT)
Entity Type:Individual
Prefix:
First Name:KAMILLE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10953 TARA VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-7984
Mailing Address - Country:US
Mailing Address - Phone:404-922-3117
Mailing Address - Fax:
Practice Address - Street 1:10953 TARA VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-7984
Practice Address - Country:US
Practice Address - Phone:404-922-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22237348106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician